Or. Admin. R. 410-149-0140 - Performance Based Incentive Payments (PBIP)

(1) To assess quality performance and eligibility for the CPC+ PBIP, both Track 1 and Track 2 practices shall be required to report electronic clinical quality measures (eCQM) to CMS annually at the practice site level.
(2) Additional PMPM payments shall be available based on performance measures included in eCQM from CMS and utilization measures calculated by the Authority:
(a) Practices must report to CMS on the amount of eCQMs required by CMS for the measurement period in order to receive PBIP payments;
(b) PBIP payments may be issued prospectively prior to eCQM performance results and reconciled at a later date when eCQM performance is available.
(3) PBIP vary by practice track and are issued in the following amounts:
(a) Track 1:
(A) PMPM amount for achieving maximum eCQM targets is $1;
(B) PMPM amount for achieving maximum utilization targets is $1.
(b) Track 2:
(A) PMPM amount for achieving maximum eCQM targets is $2;
(B) PMPM amount for achieving maximum utilization targets is $2.
(4) Practices shall be eligible to achieve the maximum eCQM and utilization incentive amounts or partial amounts. Incentive percentage available shall be calculated by CMS based on each individual eCQM measure and by the Authority for two utilization measures.

Notes

Or. Admin. R. 410-149-0140
DMAP 31-2017(Temp), f. 7-28-17, cert. ef. 8-1-17 thru 1-27-18; DMAP 5-2018, adopt filed 01/24/2018, effective 1/24/2018

Statutory/Other Authority: 413.042

Statutes/Other Implemented: 413.042, 413.259 & 414.065

State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.